Provider Demographics
NPI:1164592531
Name:BEXAR COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:BEXAR COUNTY HOSPITAL DISTRICT
Other - Org Name:UNIVERSITY DIALYSIS SOUTHEAST
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REED
Authorized Official - Middle Name:
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-358-2101
Mailing Address - Street 1:4502 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-4493
Mailing Address - Country:US
Mailing Address - Phone:210-358-4000
Mailing Address - Fax:210-702-4159
Practice Address - Street 1:1407 FAIR AVE
Practice Address - Street 2:MAIL STOP 639-4
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1439
Practice Address - Country:US
Practice Address - Phone:210-358-5780
Practice Address - Fax:210-358-5790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007304261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX453504Medicare Oscar/Certification